What do I need to accomplish today?Survey the work area and review JHA1-2-3-4-Company:_______________________________Job/Task covered:_________________________Give Job InstructionJob #:__________ Date:____________LACKOFKNOWLEDGEORSKILLis one of themost frequent causes of accidents. The supervisormust show the employee how to perform their joband must make sure that each employee has theknowledge and skill to perform their job safely.Equipment Needed for Task(s).Tools Needed for Task(s).Supervisor:______________________________PRIOR TO START OF TASKEstablish Work MethodsA supervisor must establish work methods that arewell understood and consistently followed in orderto ensure efficient and safe operations.Hazards need to be recognized beforethey occurso proper controls can be implemented to obtain anacceptable level of risk. It is the supervisors’responsibility to routinely survey the work area to:1. Identify unsafe conditions.2. Follow up on any deficiencies.3. Identify the appropriate corrective action.PRE-TASK PLANshall be reviewed with each crew.Prior to each days work a Pre-Task PlanACTION ITEMSEmployees covered by this Pre-Task PlanInitial here.___________________________ _______Assign people to tasks.___________________________ _______Did I complete my tasks?___________________________ _______ Yes No___________________________ _______1-___________________________ _______2-___________________________ _______3-___________________________ _______4-___________________________ _______Supervising people at work___________________________ __________________________________ _______Name:___________________________ _______Reason:___________________________ _______Name:___________________________ _______Reason:(complete reprimand form for written warnings)Rev. 12/5/2012Whenever a supervisor makes a job assignment,safety as well as good job performance requiresthat they be sure the employee is qualified to do thejob and thoroughly understands the work method.Remember even the most experienced workerneeds some direction.Warnings IssuedReview the Pre-Task Plan with your employees!Complete and return this form to your superintendentWhen people deviate from the established safepractices, accidents and injuries occur. Supervisingpeople at work is necessary to prevent this. Thesupervisor must watch for unsafe work methodsand correct them as soon as they are observed.Print NameFalling ObjectsHigh NoiseHarness and LanyardsInspected DailyWalking / Working SurfacesRetractable LanyardsTied/braced/guys at 4:1Slips / Trips / FallsGuard RailsFully PlankedHot Surfaces/welding/cuttingHole CoversGuardrails installedHeavy LiftingFloor / Wall OpeningsAccess Ladders UsedSharp ObjectsFalling MaterialEye HazardsHorizontal LifelinesHand HazardsVertical LifelinesPermit Required/CompletedFoot HazardsAtmosphere Tested and OKFalls From over 6 footAttendant log with Hole WatchLeading Edge WorkPower tools inspectedRetrieval Equipment at LocationFloor / Wall OpeningsCheck CordsClimbing LaddersGround Pins in placePinch PointsGFCI UsedFresh Water and CupsHand / Power toolsDamaged Tools / Cords RemovedFirst Aid Kit AvailableExcavations / TrenchesLockOut / TagoutRest Rooms AvailableScaffoldingMSDS AvailableTrafficTrash and Debris ContainedMachinery / EquipmentCompetent PersonMaterial StackedElectricalBlue Stakes calledExcavationsPotential HazardsHazard Elimination(cont'd)Hazard Elimination(cont'd)Confined SpaceElectricalHealth and HousekeepingFall Protection ScaffoldsRiggingShoring/Benching/SlopingOther CraftsAccess LaddersAny near miss today? Yes / NoStruck ByBarricadesWater ControlledReported to Safety? Yes / NoNear miss form completed?Yes / NoInspected / greased dailyAction taken to prevent reoccurance:Hard HatBe Aware of Pinch PointsSafety GlassesStay out from under loadsReflective OrangeInspect RiggingFace ShieldSpotterGlovesAccidents/injuries reported? Yes / NoRespiratorsFoot ProtectionLadders tied and secureName:Ear PlugsLadders extend 3' above landing4:1 RatioReported to Safety? Yes / NoStep ladders opened and lockedIncident report completed?Yes / NoFire Extinguishers chargedKeep 3 Points of ContactWater Hose on handBelt Buckle RuleSupervisor sign and date at end of shiftFlammables/Combustables isolatedHot Work PermitCommunication with Others__________________________ __________Signature DateNear Miss/Incident ReportsHazard EliminationFire ProtectionP.P.E.EquipmentLadders